Association of Patient Belief About Success of Antibiotics for Appendicitis and Outcomes
Authors: Mohamad Abouzeid, Hasan B. Alam, Hikmatullah Arif, Karla Ballman, Robert Bennion, Karla Bernardi, Debra Burris, Damien Carter, Patricia Chee, Formosa Chen, Bruce Chung, Sunday Clark, Randall Cooper, Joseph Cuschieri, Kimberly Deeney, Naila Dhanani, Thomas Diflo, F. Thurston Drake, Cathy Fairfield, Farhood Farjah, Lisa Ferrigno, Katherine Fischkoff, Ross Fleischman, Careen Foster, Terilee Gerry, Melinda Gibbons, Mary Guiden, Nathan Haas, Lillian Adrianna Hayes, Alyssa Hayward, Laura Hennessey, Miriam Hernandez, Karen F. Horvath, Erin C. Howell, Cindy Hsu, Jeffrey Johnson, Billie Johnsson, Dennis Kim, Daniel Kim, Tien C. Ko, Danielle C. Lavallee, Debbie Lew, Joseph Mack, David MacKenzie, Jason Maggi, Stephanie Marquez, Ryan Martinez, Karen McGrane, Marcovalerio Melis, Karen Miller, Debbie Mireles, Gregory J. Moran, Dayna Morgan, Arden Morris, Kelly M. Moser, Lauren Mount, Kathleen O'Connor, Stephen R. Odom, Oscar Olavarria, Norman Olbrich, Scott Osborn, Olga Owens, Pauline Park, Zoe Parr, Charles S. Parsons, Kavitha Pathmarajah, Deepti Patki, Joe H. Patton, Rebekah K. Peacock, Kristyn Pierce, Kelsey Pullar, Brant Putnam, Amy Rushing, Amber Sabbatini, Darin Saltzman, Matthew Salzberg, Shaina Schaetzel, Paul J Schmidt, Paresh Shah, Nathan I. Shapiro, Prashant Sinha, Dionne Skeete, Elliott Skopin, Vance Sohn, Lara H. Spence, Steven Steinberg, Aleksandr Tichter, John Tschirhart, Brandon Tudor, Lisandra Uribe, Heather VanDusen, Julie Wallick, Meridith Weiss, Sean Wells, Abigail Wiebusch, Estell J. Williams, Robert J. Winchell, Jon Wisler, Bruce Wolfe, Erika Wolff, Donald M. Yealy, Julianna Yu, Irene Y. Zhang, Emily C. Voldal, Giana H. Davidson, Joshua M. Liao, Callie M. Thompson, Wesley H. Self, Lillian S. Kao, Jill Cherry-Bukowiec, Krishnan Raghavendran, Amy H. Kaji, Daniel A. DeUgarte, Eva Gonzalez, Katherine A. Mandell, Kristen Ohe, Nicole Siparsky, Thea P. Price, David C. Evans, Jesse Victory, William Chiang, Alan Jones, Matthew E. Kutcher, Hailie Ciomperlik, Mike K. Liang, Heather L. Evans, Brett A. Faine, Miriam Neufeld, Sabrina E. Sanchez, Anusha Krishnadasan, Bryan A. Comstock, Patrick J. Heagerty, Sarah O. Lawrence, Sarah E. Monsell, Erin E. C. Fannon, Larry G. Kessler, David A. Talan, David R. Flum
Journal: JAMA Surgery (2022)

A patient's belief in the likely success of a treatment may influence outcomes, but this has been understudied in surgical trials.To examine the association between patients' baseline beliefs about the likelihood of treatment success with outcomes of antibiotics for appendicitis in the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial.This was a secondary analysis of the CODA randomized clinical trial. Participants from 25 US medical centers were enrolled between May 3, 2016, and February 5, 2020. Included in the analysis were participants with appendicitis who were randomly assigned to receive antibiotics in the CODA trial. After informed consent but before randomization, participants who were assigned to receive antibiotics responded to a baseline survey including a question about how successful they believed antibiotics could be in treating their appendicitis.Participants were categorized based on baseline survey responses into 1 of 3 belief groups: unsuccessful/unsure, intermediate, and completely successful.Three outcomes were assigned at 30 days: (1) appendectomy, (2) high decisional regret or dissatisfaction with treatment, and (3) persistent signs and symptoms (abdominal pain, tenderness, fever, or chills). Outcomes were compared across groups using adjusted risk differences (aRDs), with propensity score adjustment for sociodemographic and clinical factors.Of the 776 study participants who were assigned antibiotic treatment in CODA, a total of 425 (mean [SD] age, 38.5 [13.6] years; 277 male [65%]) completed the baseline belief survey before knowing their treatment assignment. Baseline beliefs were as follows: 22% of participants (92 of 415) had an unsuccessful/unsure response, 51% (212 of 415) had an intermediate response, and 27% (111 of 415) had a completely successful response. Compared with the unsuccessful/unsure group, those who believed antibiotics could be completely successful had a 13-percentage point lower risk of appendectomy (aRD, -13.49; 95% CI, -24.57 to -2.40). The aRD between those with intermediate vs unsuccessful/unsure beliefs was -5.68 (95% CI, -16.57 to 5.20). Compared with the unsuccessful/unsure group, those with intermediate beliefs had a lower risk of persistent signs and symptoms (aRD, -15.72; 95% CI, -29.71 to -1.72), with directionally similar results for the completely successful group (aRD, -15.14; 95% CI, -30.56 to 0.28).Positive patient beliefs about the likely success of antibiotics for appendicitis were associated with a lower risk of appendectomy and with resolution of signs and symptoms by 30 days. Pathways relating beliefs to outcomes and the potential modifiability of beliefs to improve outcomes merit further investigation.ClinicalTrials.gov Identifier: NCT02800785.